Over Half of US Adults with Uncontrolled HTN Unaware of Their Condition: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On September 13, 2024, we reported on a study published in JAMA Network Open that examined the prevalence of hypertension (HTN) control cascade outcomes, specifically HTN awareness, treatment recommendations, and medication use, among individuals aged 18 years and older with uncontrolled HTN.

The study

Researchers conducted a cross-sectional study of National Health and Nutrition Examination Survey (NHANES) data for 3129 individuals. They used the American College of Cardiology/American Heart Association (ACC/AHA) 2017 hypertension guidelines updated definition of the disease: systolic BP (SBP) greater than or equal to 130 mm Hg and diastolic BP (DBP) greater than or equal to 80 mm Hg, and regardless of medication use.

The main outcomes assessed were patient awareness of HTN, treatment recommendations, and medication use. Mean blood pressure was computed using up to 3 measurements. Investigators analyzed demographic factors such as age, race, ethnicity, educational attainment, income-to-poverty ratio, health insurance status, and health care visits to understand variations in HTN control. The analysis was conducted from January to February 2024.

The cohort was stratified by age into 3 subgroups: those aged 18 to 44 years (29.4%), aged 45 to 64 years (41.4%), and 65 years or older (29.2%). Population totals by subgroup were estimated by multiplying the age-standardized proportion of each outcome by the estimated number of adults with uncontrolled HTN.

The findings

The researchers calculated that the weighted percentage of individuals with uncontrolled hypertension (83.7%; 95% CI, 80.6%-86.8%) corresponded with an estimated 100.4 million US adults. They found that more than half (57.6%) with uncontrolled disease were not aware of that fact. Less than 1 in 5 (17.8%) were aware they met criteria for uncontrolled HTN and so were eligible for lifestyle modification measures recommended in the ACC/AHA 2017 guidelines.

Among the 35 million participants whose hypertension was uncontrolled and met guideline criteria for antihypertensive medication from January 2017 to March 2020, less than three-quarters of them (70.8%) reported doing so and so remained uncontrolled. Prevalence of uncontrolled HTN was highest (93.4%) among younger adults, aged 18 to 44 years, a group that investigators found had particularly low disease awareness.

Authors' comment

"These findings underscore the need for efforts to improve outcomes across levels of the hypertension control cascade."

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